Social Inequalities in Health

what are health inequalities?

Avoidable and unfair differences in peoples health, the care they receive or opportunities they have to live healthily.

what can be used to measure health inequalities?

some include:

• life expectancy

• behaviour

• access to services

• recovery from COVID

• we can also look at what determines the inequality (eg: IMD)

what are these health inequalities between?

• social characteristics - gender, age, ethnicity, sexuality, disability…

• socioeconomic characteristics - income, education, occupation

• places/ geography - regions, countries, neighbours, types of place (rural vs urban)

• minority groups - people experiencing homelessness …

what is the difference between health inequalities and health inequities?

• inequalities = inequal distribution of resources

• inequities = unfair and avoidable differences arising from poor governance, cultural exclusion or competition

Methods of reducing childhood poverty?

• free school meals

• child benefit cap (not just two children)

• Free childcare hours = allows parents to work

How can we measure deprivation?

Index of multiple deprivation (IMD) - has 7 domains:

• income

• employment

• education

• health

• crime

• housing

• environment

where are some of the most deprived areas in the UK - based on the 2025 IMD?

• Middlesborough

• Birmingham

• Hartlepool

• Kingston upon Hull

• Manchester

How are life expectancy and healthy life expectancy linked to deprivation?

LE = highest in the least deprived areas and lowest in the most deprived

Infant mortality = equally linked - lowest on most deprived

what is the inverse care law?

Inverse relationship between patient needs and the resources available

• in areas with the most sickness/death GPs have more work, larger lists, less hospital support than in the healthiest areas.

How were records of mortality kept in C19th Britain?

• recorded by social class in parish records based on main household occupation

• gentry & professional, farmers & tradesman, artisans & labourers

what is the registrar generals social class (1913)?

• way of classifying people by socioeconomic class using census data for the 1st time to better understand rapid urbanisation

• Widely used in medicine to compare mortality and health, proven to be highly predictive of mortality and a range of health outcomes

• I, II, III = non-manual

• III, IV, V = manual

what is the national statistics socioeconomic classification?

• more detailed than RGSC - established in 2000 and now widely used in medical research

• social class by occupation

• But now boarder definitions of social class

what is socioeconomic status?

Any measure which attempts to classify individuals, families, or households in terms of indications such as occupation, income and education.

what are the social determinants of health?

They are the conditions in which people are born, grow up in , work, age and the wider set of forces and systems shaping the conditions of daily life.

in what 3 ways can the SDH be though of?

• material

• psychological

• behavioural

how might material intermediaries impact someone’s health

Examples: finances, food, clothing - could also be physical condition where someone lives/works

• Poverty/economic hardship = damp housing, inability to afford food or travel to access healthcare services = poorer health outcomes

• Also works conversely - accumulating health advantage

what are the psychological intermediaries that impact health

they are the stressors and emotional wellbeing that connects lived experience with health.

• eg: financial stress or instability

• eg: poor mental and physical health (through biological mechanisms)

what are the behavioural intermediaries that impact health?

Individual activities eg: smoking, drinking, poor eating

• linked to a persons cultural and social environment as well as their physical environment

what did the black report,1982 suggest were explanations for inequalities in health?

• it was a statistical artifact (not real)

• that peoples health impacts their social class (health related social morbidity)

• result of differences in health behaviour

• result of boarder social inequalities in peoples lives

what was the 2010 Marmot review?

A government funded report to answer the simple question - why do some people in England live longer, healthier lives than others, and what can be done to reduce this gap.

what did the marmot review find

• those who live in the poorest neighbourhoods = die 7yrs earlier than others

• lower SES = more likely to be of poor health

• living in more deprived areas = spend more time in ill health

• health inequalities = expensive (eg; NHS costs) and are highly linked to social inequalities

Based on the marmot review what was recommended?

That the gov take action to improve the SDH - disadvantage starts at birth, and continues throughout life. therefore the best place to intervene and target help is at birth.

What is inclusion health?

Services, research, policy that looks to reduce inequalities/inequities by supporting specific groups that are particularly vulnerable and are often excluded from HC services.

what can Drs do to promote inclusion health?

• be patients advocates - listen and speak up for patients

• consider if services are accessible and equitable

• longitudinal thinking and person centred care for complex social inequalities